| NPI | 1164859336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: DE E1-0000235) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA sc006482) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: DE E1-0000235) | |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2016-09-28 |