| NPI | 1588084362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 959) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: CT 959) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CT 959) | |
| 222Z00000X Orthotist (Licence: CT 959) | |
| 225000000X Orthotic Fitter (Licence: 959) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2018-03-17 |