| NPI | 1841221413 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 000709) | 
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KS 266) | 
| 213E00000X Podiatrist (Licence: TN 791) | |
| Enumeration Date | 2006-07-05 | 
| Last Update Date | 2025-03-17 |