| NPI | 1982667903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WV WV 00363) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103300831) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36003209D) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2009-11-04 |