| NPI | 1790868198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901001964) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MI 5901001964) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-05-16 |