| NPI | 1629012661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CT P00289) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: CT P00289) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2015-01-07 |