| NPI | 1295904696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 853) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN TP-165) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 973-25) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2013-01-23 |