| NPI | 1326043316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901001446) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI EK001446) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2025-01-27 |