| NPI | 1689644882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO2638) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 0936) |
| 213E00000X Podiatrist (Licence: NM 187) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2008-03-31 |