| NPI | 1861563512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 0927) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E2537) |
| 213E00000X Podiatrist (Licence: FL 1314) | |
| 213E00000X Podiatrist (Licence: TX 0748) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |