| NPI | 1194747493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 1134) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: SD 255) |
| 213E00000X Podiatrist (Licence: HI PO137) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2026-06-09 |