| NPI | 1851397608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 00438) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: MD 00438) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2008-03-04 |