| NPI | 1730155896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: VA 0103300893) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0103300893) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: VA 0103300893) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2012-01-21 |