| NPI | 1689839813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: NC 01109) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101249850) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2016-11-03 |