| NPI | 1396718680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MD 00527) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DC P0350) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-07-08 |