| NPI | 1033802673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5951001518) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901400598) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2026-06-24 |