| NPI | 1558498402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AK 2810) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 1045450501) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2016-10-18 |