| NPI | 1346767258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901002712) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5901002712) |
| 207Q00000X Family Medicine (Licence: MI 5901002712) | |
| 207R00000X Internal Medicine (Licence: MI 5901002712) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5901002712) | |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2022-07-21 |