| NPI | 1144420118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: TN DPM 400) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MS 80116) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2009-05-06 |