| NPI | 1871741355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 01511) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MD 01511) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: MD 01511) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2011-09-13 |