| NPI | 1487603346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: CT CT000214) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CT 000214) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2012-08-21 |