| NPI | 1821017799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO2860) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO2860) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: FL PO2860) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2016-06-10 |