| NPI | 1831149103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ AZ00316) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 0316) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2014-01-28 |