| NPI | 1982621603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: TN DPM336) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM336) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-07-20 |