| NPI | 1477517167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TN DPM710) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 307187-501) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: LA DPM200005) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2011-01-04 |