| NPI | 1821037037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI JY001877) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901001877) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 725) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2021-09-30 |