| NPI | 1457516296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2008033461) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 000808) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KS 12-00385) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2014-03-14 |