| NPI | 1487140521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD305031) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901002756) |
| 213E00000X Podiatrist (Licence: MS 80240) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2025-02-28 |