| NPI | 1427609676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901400451) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 003928) |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2022-10-19 |