| NPI | 1730101635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 466) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: CT 466) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2018-03-17 |