| NPI | 1932131935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AR 116) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OK 172) |
| 213E00000X Podiatrist (Licence: TX 0902) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2008-01-28 |