| NPI | 1437314812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2008026233) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103300984) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005384) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2010-05-11 |