| NPI | 1093120297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901002523) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002523) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI AM002523) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MI 5901002523) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2021-11-04 |