| NPI | 1851474944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MS 80168) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103001007) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2011-01-31 |