| NPI | 1578539615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 504) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 689-25) |
| 213E00000X Podiatrist (Licence: MN 689-25) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2021-12-08 |