| NPI | 1902847577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 0662) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 5611087-0501) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2015-06-18 |