| NPI | 1356703185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO 3811) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO 3811) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2016-08-23 |