| NPI | 1346244803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901000968) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901000968) |
| Enumeration Date | 2005-06-11 |
| Last Update Date | 2010-01-04 |