| NPI | 1720079163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL P03305) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36-003432) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002108) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2019-05-21 |