| NPI | 1003080102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 1024-25) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI MK002134) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2013-06-07 |