| NPI | 1558348557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MN 509) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 509) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2020-07-15 |