| NPI | 1134148307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IA 097112) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MN 016005204) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-02-12 |