| NPI | 1245238385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA DPM2323) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: RI DPM00279) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2016-06-03 |