| NPI | 1619537255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901400491) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213E00000X Podiatrist (Licence: MI 5901400491) | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2023-08-21 |