| NPI | 1669420659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: DE E10000070) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 00633) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2014-03-10 |