| NPI | 1003861964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901001380) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI DS001380) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901001380) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2022-05-11 |