| NPI | 1760556765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VT VT0560000101) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NH NH0277) |
| 213E00000X Podiatrist (Licence: MA MA1543) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |