| NPI | 1194177782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ POD-001015) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 10383566-0501) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2022-09-02 |