| NPI | 1194704023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01135) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DC PO499) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2023-01-27 |