| NPI | 1356344741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901001664) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI R0001664) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2013-06-26 |