| NPI | 1326254848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SC POD.614 POD) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3095) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2017-04-27 |