| NPI | 1558387423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 2078) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 002078) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2019-08-07 |