| NPI | 1588606347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TN 531) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN 531) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN 0531) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: TN 531) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: TN 531) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-08-19 |