| NPI | 1003885617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 444) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 444) |
| 213E00000X Podiatrist (Licence: MO 759) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MN 444) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: MN 444) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 759) | |
| 183500000X Pharmacist (Licence: MN 113462) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2011-11-14 |