| NPI | 1922036086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO3445) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 556) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2014-09-23 |