| NPI | 1689617011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002161) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901002161) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MI 5901002161) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-02-19 |