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 |