| NPI | 1366408221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01392) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DC PO1000041) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2010-08-21 |