| NPI | 1164513099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: HI PO-208) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV WV342) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-02-14 |