| NPI | 1245266220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901001979) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901001979) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2021-06-15 |