| NPI | 1508885872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO3147) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3147) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-10-22 |