| NPI | 1033284179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 1939) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MA 1939) |
| 213ES0131X (Licence: MA 1939) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: MA 1939) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2015-09-21 |