| NPI | 1639307952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA POD001194) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006106) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00360) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2013-06-10 |