| NPI | 1629066337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 0806) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: AZ 0806) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2016-01-29 |