| NPI | 1205889417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 770) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: SD 187) |
| 213E00000X Podiatrist (Licence: IA 00764) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MN 770) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-10-04 |