| NPI | 1467781153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ER0200X Podiatrist, Radiology (Licence: MD D0000378) |
| Additional Taxonomies | 172A00000X Driver (Licence: MD D0000378) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2009-12-09 |