| NPI | 1295724839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: SC 525) |
| Additional Taxonomies | 213ES0131X (Licence: SC 525) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2013-10-29 |