| NPI | 1689626020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000717) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CT 000717) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CT 000717) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2008-03-24 |