| NPI | 1598928525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA 1197) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 1197) |
| 213ES0131X Podiatrist Foot Surgery (Licence: MA 1197) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2016-06-14 |