| NPI | 1598826968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3476) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DC P0596) |
| 213E00000X Podiatrist (Licence: VA 0101100862) | |
| 213E00000X Podiatrist (Licence: MD 01278) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3476) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2011-12-07 |