| NPI | 1790857969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT P00232) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CT P00232) |
| 213ER0200X Podiatrist, Radiology (Licence: CT P00232) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: CT P00232) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CT p00232) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2008-03-17 |