| NPI | 1649273814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 0574) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4366) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2008-01-31 |