| NPI | 1770638884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 2010001728) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KS 1200259) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2010-08-10 |