| NPI | 1902821242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: GA 000931) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: GA 000931) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2011-01-28 |