| NPI | 1891751913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA PD 1645) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 1645) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MA 1645) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-08-02 |