| NPI | 1225299449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 890) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: MN 890) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WI 986-025) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MN 890) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2020-11-10 |