| NPI | 1861499519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901001039) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901001039) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-11-23 |