| NPI | 1790795250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist Sports Medicine (Licence: OR DP00376) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OR LL15335) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2008-02-07 |