| NPI | 1508847633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MN 486) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: MN 486) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2018-10-23 |