| NPI | 1548245699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 1520) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 1520) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: MA 1520) | |
| 213ES0131X (Licence: MA 1520) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2019-09-12 |