| NPI | 1124446166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901400531) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NE 365) |
| 213E00000X Podiatrist (Licence: IA 086664) | |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2024-07-12 |