| NPI | 1396788873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: CO 595) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CO 595) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-03-17 |