| NPI | 1306833587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL po2521) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO2521) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2017-07-21 |