| NPI | 1225321839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 952) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001251) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ND 75) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2021-03-08 |