| NPI | 1477595361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO-0001221) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: FL PO-0001221) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO-0001221) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2008-07-03 |