| NPI | 1346241510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 164) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: CT 164) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CT 164) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2008-03-10 |