| NPI | 1376529479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: GA 000582) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA GA582) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2010-03-04 |