| NPI | 1013151331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5024) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901002240) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2022-04-18 |