| NPI | 1346217031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 286) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 286) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2024-08-29 |