| NPI | 1316027386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VT 056-0000137) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NH 0238) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |