| NPI | 1356574651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3461) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: FL PO3461) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2012-03-19 |