| NPI | 1023088416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NH 0135) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 1499) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2017-02-28 |