| NPI | 1396789806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103000907) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: VA 0103000907) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2015-09-30 |