| NPI | 1427014034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001192) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36003505) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: AZ 0620) | |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2012-07-18 |