| NPI | 1770595514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: CO 457) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: WY 102) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-07-08 |