| NPI | 1881627545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001123) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N005570) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2013-04-04 |