| NPI | 1952570996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO 0000416) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO 0000416) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2018-09-04 |