| NPI | 1780795211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA sc003770l) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA sC003770l) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-03-13 |