| NPI | 1740251750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO0002020) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO0002020) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2019-01-21 |