| NPI | 1992708341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO1127) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901000830) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-03-29 |