| NPI | 1306820956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: CT 000709) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: MA 2097) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT 00709) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2015-02-20 |