| NPI | 1487668919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 586) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KS 12/00327) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-03-10 |