| NPI | 1891734034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AL 329) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: LA PD146R) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2018-04-19 |