| NPI | 1407892086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 1556) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: MA 1556) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2007-07-08 |