| NPI | 1417946591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NH 0333) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MI 5901001395) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM 0328) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2014-05-02 |