| NPI | 1487612610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901000775) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5901000775) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2012-03-28 |