| NPI | 1710969217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO2551) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL P02551) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2013-04-23 |