| NPI | 1518999630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: MS 80196) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM0000000655) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2009-08-03 |