| NPI | 1932356805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 692) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901002239) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2017-03-21 |