| NPI | 1871749614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AZ 0272) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 0405) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2008-08-12 |