| NPI | 1952455370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 049981) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MS 80178) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2016-03-02 |