| NPI | 1558775304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 1070) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN TP-203) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2020-11-09 |