| NPI | 1306828199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 9410M1971) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 000660) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2013-01-15 |