| NPI | 1184695306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN 628) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: LA PD0142) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2017-12-27 |