| NPI | 1821098427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 000365) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KS 12-00116) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2007-12-07 |