| NPI | 1154784023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 000929) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002634) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2020-10-21 |