| NPI | 1972693281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1152) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: TX 1152) |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2010-04-07 |