| NPI | 1538332010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN 693) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 244013) |
| 213E00000X Podiatrist (Licence: IA 0795t) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2019-01-25 |