| NPI | 1194259747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901400360) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MI 5901400360) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2023-07-13 |