| NPI | 1376848077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MS 80220) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901002375) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2015-02-24 |