| NPI | 1407040439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO 3324) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CT 823) |
| Enumeration Date | 2007-09-03 |
| Last Update Date | 2008-04-28 |