| NPI | 1407079874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL P01651) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: FL PO1651) |
| 213ES0000X Podiatrist Sports Medicine (Licence: FL PO1651) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL P01651) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2014-07-08 |