| NPI | 1144331083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X (Licence: TX 1084) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 1084) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX 1084) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-01-07 |