| NPI | 1487653440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103000375) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 179) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2009-12-03 |