| NPI | 1437138898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 000751) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KS 12-00251) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2019-11-20 |