| NPI | 1194064675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001164A) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: NY P76610) |
| 213E00000X Podiatrist (Licence: MI 5901002608) | |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2015-09-15 |