| NPI | 1376501221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN DPM0000000489) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD000785) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2022-04-06 |