| NPI | 1801246186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: LA 311931) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 082181) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2019-08-07 |