| NPI | 1649217712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 488) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 488) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2008-03-11 |