| NPI | 1992782999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SC 124) |
| Additional Taxonomies | 193400000X Single Specialty (Licence: SC 124) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2016-03-30 |