| NPI | 1376629816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN DPM0000000720) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301055) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2012-01-26 |