| NPI | 1508871286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AL 99) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36-00-2225-W) |
| 213E00000X Podiatrist (Licence: GA POD000548) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2007-07-08 |