| NPI | 1194768556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO4160) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NH 0295) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-04-21 |