| NPI | 1457447864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103001054) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: VA 0103001054) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0103001054) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: VA 0103001054) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2010-07-12 |