| NPI | 1285631382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO 3045) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO 3045) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2008-12-03 |