| NPI | 1649502436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002404) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PL60020323) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2011-06-14 |