| NPI | 1316975592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000408) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CT 000408) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2008-02-06 |