| NPI | 1417034323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01470) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: FL PO3276) |
| 213ES0131X Podiatrist Foot Surgery (Licence: FL PO3276) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2009-08-03 |