| NPI | 1518958925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 584) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 877-025) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: WI 877-025) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2022-02-22 |