| NPI | 1629148648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 2000172198) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KS 1200321) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |