| NPI | 1396764098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901002383) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 3286) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: SC 574) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002383) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-05-13 |