| NPI | 1861496853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN DPM0000000591) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN DPM0000000591) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: TN DPM0000000591) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2007-12-06 |