| NPI | 1699794693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SD 188) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: SD 188) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-02-06 |