| NPI | 1568467082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MI 5901001221) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: MI 5901001221) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MI 5901001221) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2014-06-24 |