| NPI | 1518206945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MD 01559) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 01559) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2020-09-28 |