| NPI | 1003170333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO POD.0000760) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002461) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301153) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2017-02-28 |