| NPI | 1275591182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103300949) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001004A) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2008-01-07 |