| NPI | 1447486980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SC 617) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA sc006156) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2016-10-07 |