| NPI | 1497785919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901001084) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 10084) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2017-05-05 |