| NPI | 1487688990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ID P-166) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ID P-166) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-06-20 |