| NPI | 1942290069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI ME001014) |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric (Licence: MI MG001014) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2007-11-02 |