| NPI | 1366424186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MT MED-POD-LIC-33740) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA 000459) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2014-10-06 |