| NPI | 1457345803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000654) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 000654) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT 0000654) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2022-02-18 |