| NPI | 1861454332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: DC PO1000017) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DC PO1000017) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: DC PO1000017) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2008-09-02 |