| NPI | 1417008467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: GA GA447) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: GA GA447) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: GA GA447) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA GA447) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2008-06-25 |