| NPI | 1336245125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: MO 000750) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: KS 1200289) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2012-02-28 |