| NPI | 1013250950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MT MED-POD-LIC-67915) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: ID P-239) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2021-03-12 |