| NPI | 1164833554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 725) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901002667) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 725) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: NC 725) | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2022-08-09 |