| NPI | 1174591150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 00192) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 205410) |
| 213E00000X Podiatrist (Licence: MO 000021319) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2007-07-08 |