| NPI | 1033471990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 1151) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MD 01584) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2023-08-31 |