| NPI | 1699761874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SC 522) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: SC 522) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2011-04-21 |