| NPI | 1558588582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901002201) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: MI 5901002201) |
| 146L00000X Emergency Medical Technician, Paramedic | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2019-09-06 |