| NPI | 1952461204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: LA DPM.PD314R) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AL 266) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2010-02-23 |