| NPI | 1336140482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 126) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07000339A) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2013-02-04 |