| NPI | 1649395237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI EM000833) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI EM000833) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2022-07-21 |