| NPI | 1396746327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 000502) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MO 000502) |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2007-10-05 |