| NPI | 1689654030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 595) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NM 294) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2010-11-24 |