| NPI | 1699763540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ID P-99) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: ID P-99) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2008-12-05 |