| NPI | 1669607040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002671) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003614) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00399) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2022-07-21 |