| NPI | 1578598017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 88) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: TX 88) |
| 213ES0131X Podiatrist Foot Surgery (Licence: NC 88) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-08 |