| NPI | 1053317479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MI 5901001045) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901001045) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2016-11-22 |