| NPI | 1073636338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MA 1789) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NH 0188) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL P00001988) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2007-07-08 |