| NPI | 1053417451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: DC P0265) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 00324) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2014-07-09 |