| NPI | 1174549216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL P01445) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL 213ES0103X) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2011-09-27 |