| NPI | 1851392138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000749) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: CT 000749) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CT 000749) | |
| 213EP0504X Podiatrist, Public Medicine (Licence: CT 000749) | |
| 213ER0200X Podiatrist, Radiology (Licence: CT 000749) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: CT 000749) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2007-10-30 |