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 |