| NPI | 1063494847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000305) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CT 000305) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2007-07-08 |