| NPI | 1386695245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WV 00231) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103000788) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |