| NPI | 1568548220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD000679) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM0000000417) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-02-27 |