| NPI | 1053554600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0749) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ 0749) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002287) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003566) | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2024-04-23 |