| NPI | 1619970381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NE 159) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NE 159) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: IA 00365) | |
| 213E00000X Podiatrist (Licence: IA 00365) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2013-01-02 |