| NPI | 1649383415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: HI PO131) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: HI PO131) |
| 213ES0000X Podiatrist Sports Medicine (Licence: HI PO131) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: HI PO131) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |