| NPI | 1104800226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO4108) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD1035) |
| 213E00000X Podiatrist (Licence: TN DPM0000000651) | |
| 213E00000X Podiatrist (Licence: FL po2511) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2019-11-06 |