| NPI | 1508879826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 676) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WI 676) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: WI 676) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2010-02-24 |