| NPI | 1215081989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: DC PO466) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: DC PO466) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-09 |