| NPI | 1750367009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI JM002024) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI JM002024) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2011-05-03 |