| NPI | 1033432521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: MS 80208) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM721) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2017-02-28 |