| NPI | 1477817179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 613) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006380) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2014-12-02 |