| NPI | 1518962091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 360) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 360) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2013-02-18 |