| NPI | 1174519516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VT 056-0000155) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NH 0259) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2008-07-02 |