| NPI | 1629417506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 1027) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN EL1859) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA 5140) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2023-08-31 |