| NPI | 1871606608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000436) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 1803) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2009-03-26 |