| NPI | 1508946054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: CT 000027) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: CT 000027) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2016-05-19 |