| NPI | 1326434986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901002592) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 183500000X Pharmacist (Licence: MI 5315072432) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2022-08-23 |