| NPI | 1841221413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN 791) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 000709) |
| 213E00000X Podiatrist (Licence: KS 266) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-07-21 |