| NPI | 1174511521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2001015897) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 2001015897) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MO 200105897) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: MO 2001015897) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2007-10-19 |