| NPI | 1386806917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0729) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ 0729) |
| 213E00000X Podiatrist (Licence: MI 5901002297) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2021-07-20 |