| NPI | 1518167840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: DC PO347) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103000432) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2007-08-28 |