| NPI | 1992794200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI SV001569) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901001567) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2007-07-08 |