| NPI | 1255506101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2008029034) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KS 12-00395) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2013-12-17 |