| NPI | 1205012044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NV 59) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NV 59) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2008-04-16 |