| NPI | 1679521835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NH 287) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: ME POD 1026) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2014-12-05 |