| NPI | 1558725473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901400410) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: MI 5901400410) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2023-11-01 |