| NPI | 1740285022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103300931) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 01424) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: DC PO1000043) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016-005169) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2007-12-07 |