| NPI | 1285639427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 716) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WI 716) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MN 816) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2018-05-02 |