| NPI | 1407213903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001235A) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO 3787) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2016-06-08 |