| NPI | 1548230311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 0000521) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MN 0000521) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2020-08-24 |