| NPI | 1396836599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MS 80046) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: LA PD0073) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |