| NPI | 1780175687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901400415) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901002723) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5951000847) | |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2021-12-27 |