| NPI | 1457703597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002654) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MI 5901002654) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2021-04-28 |