| NPI | 1265746556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 000837) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: SD 215) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2021-07-28 |