| NPI | 1780686667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL P02951) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: FL P02951) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2011-10-27 |