| NPI | 1366400517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP00171) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: OR DP00171) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2010-08-24 |