| NPI | 1477521987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: MS 80190) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 1309) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2011-06-08 |