| NPI | 1013209071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 2088) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001246) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2016-10-14 |