| NPI | 1336238336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 154) |
| Additional Taxonomies | 213EP0504X Podiatrist Public Medicine (Licence: NC 154) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 154) | |
| 213ER0200X Podiatrist Radiology (Licence: NC 154) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: NC 154) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: NC 154) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2016-04-04 |