| NPI | 1386746808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901001631) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 590101001631) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2019-08-15 |