| NPI | 1023457116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 0833) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901002478) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2024-08-19 |