| NPI | 1629138607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901000884) |
| Additional Taxonomies | 213ES0131X (Licence: MI 5901000884) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2015-02-25 |