| NPI | 1871531988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: CT 000598) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CT 000598) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT 000598) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2013-02-11 |