| NPI | 1104865476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901001753) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MI 5901001753) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-10-26 |