| NPI | 1629059951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI RF001043) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901001043) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2009-02-20 |