| NPI | 1043208242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MA 1793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 735510) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2008-04-24 |