| NPI | 1790746030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: MO 000598) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: KS 12-00233) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2008-05-19 |