| NPI | 1205937554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 00505) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SD 123) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NE 224) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 675) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-01-29 |