| NPI | 1184860835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 02371) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA 02371) |
| 213E00000X Podiatrist (Licence: NH 0363) | |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2018-11-19 |