| NPI | 1164412649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 445) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 746) |
| 213E00000X Podiatrist (Licence: WI 746) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 445) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2021-06-04 |