| NPI | 1669441895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: SC 533) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SC 533) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2011-04-05 |