| NPI | 1801901343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KS P124) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 398) |
| 213E00000X Podiatrist (Licence: FL 872) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2009-01-12 |