| NPI | 1184643421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MA 1606) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MA 1606) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-01-02 |