| NPI | 1881822476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2006) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: TX 2006) |
| 213E00000X Podiatrist (Licence: TX 2006) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2015-10-08 |