| NPI | 1699779066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 370449-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NV 9910) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2007-10-25 |