| NPI | 1447368196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN DPM0000000352) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM0000000352) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: TN DPM0000000352) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2010-06-11 |