| NPI | 1265429468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 0422) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DC 290) |
| 213E00000X Podiatrist (Licence: VA 373) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2010-09-27 |