| NPI | 1588667687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NC 354) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NC 354) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 354) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2015-09-21 |