| NPI | 1710986047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002082) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36.003379) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2017-02-28 |