| NPI | 1275619603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NV 1201) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07000745A) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2019-10-28 |