| NPI | 1447390034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: DC PO599) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 01297) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |