| NPI | 1932196631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VT VT78) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NH NH116) |
| 213E00000X Podiatrist (Licence: MA MA1390) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2007-07-08 |