| NPI | 1649241977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 33466) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MN 33466) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2024-08-27 |