| NPI | 1265538979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: VA 0103000983) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC0032299L) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2012-10-10 |