| NPI | 1265432009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: DC PO1000036) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC PO1000036) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2016-09-19 |