| NPI | 1598043754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IA 073734) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016.005620) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2014-09-11 |