| NPI | 1093339558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901400474) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5951001372APP20) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2024-04-19 |