| NPI | 1154384980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 472) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 472) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NC 472) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NC 472) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 472) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2013-09-18 |