| NPI | 1447366695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: OK 255) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3473) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-03-25 |