| NPI | 1659309060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MI JD001490) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MI JD001490) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2015-01-13 |