| NPI | 1942208202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: CT 000750) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CT 000750) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2012-08-23 |