| NPI | 1750305892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TN DPM283) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: TN DPM283) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-11-21 |