| NPI | 1346291325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: NC 432) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 432) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 432) | |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2014-06-26 |