| NPI | 1528632833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5951001426) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5951001426APP21) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2024-05-21 |