| NPI | 1982740668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AK 3430) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IN 07001453A) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2024-02-27 |