| NPI | 1720053606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ME POD1023) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00320) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2014-06-12 |