| NPI | 1275521601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AR 197) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1597) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 218) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2012-11-07 |