| NPI | 1396748497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CO POD.0000548) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO2824) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2022-11-04 |