| NPI | 1386715514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MS 80100) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TN DPM0000000341) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2013-07-23 |