| NPI | 1649281361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 801) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 801) |
| 213E00000X Podiatrist (Licence: WA PO00000770) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2022-03-29 |