| NPI | 1376122176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: MI 5951001419) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901400535) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2024-09-10 |