| NPI | 1356307185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 578) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 991) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WI 991) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IA 578) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2018-06-12 |