| NPI | 1427035351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 1972) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 1972) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 000578) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2008-06-26 |