| NPI | 1891849220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD MD 1191) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA 0805) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2008-03-04 |