| NPI | 1356599096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 563) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 563) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 563) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: NC 563) | |
| Enumeration Date | 2008-09-06 |
| Last Update Date | 2013-07-09 |