| NPI | 1457464067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000035) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 1422) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-11-27 |