| NPI | 1720130842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: PR 00000048) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: WI 000645) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-08 |