| NPI | 1750509691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002174) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901002174) |
| 213ER0200X Podiatrist, Radiology (Licence: MI 5901002174) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: MI 5901002174) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2008-03-03 |