| NPI | 1912972688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: IA 00774) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 00774) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2009-12-28 |