| NPI | 1033123948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO990) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI KP000796) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2007-07-08 |