| NPI | 1528011376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NC 204) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 204) |
| 193400000X Single Specialty (Licence: NC 204) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NC 204) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2016-04-04 |