| NPI | 1659465011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ME ME POD 204) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: ME ME POD 204) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2012-09-06 |