| NPI | 1578536363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2002018117) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 2002018117) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2014-04-17 |