| NPI | 1447291067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AK 5109) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AK 5109) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2011-08-24 |