| NPI | 1912993262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN TN0000000193DPM) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM0000000193) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2008-04-14 |