| NPI | 1699736736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO2767) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO2767) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO2767) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2015-08-16 |