| NPI | 1851349997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000808) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: CT 000808) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CT 000808) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2012-03-14 |