| NPI | 1306041173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO 3277) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO 3277) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2010-06-30 |