| NPI | 1346344470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901001203) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MI 5901001203) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2010-07-08 |