| NPI | 1851389100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901001669) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: MI 5901001669) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2010-11-11 |