| NPI | 1467488395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO2190) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 004375) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0761) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2013-09-03 |