| NPI | 1881690675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: FL PO1253) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO1253) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2011-12-14 |