| NPI | 1073843587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 844) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN TP-169) |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2011-12-07 |