| NPI | 1841532421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901002616) |
| Additional Taxonomies | 213ES0131X (Licence: MI 5901002616) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2016-07-11 |