| NPI | 1891739991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103 000583) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 219) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2013-03-29 |