| NPI | 1942269691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 00498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 00498) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2010-02-16 |