| NPI | 1326008277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 649-025) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 105334-0501) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2007-07-09 |