| NPI | 1487602447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000516) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: CT 000516) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CT 000516) | |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: CT 000516) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2010-10-04 |