| NPI | 1144450321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4254) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901002338) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2021-02-22 |