| NPI | 1760777338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN MN910) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MN 910) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 910) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MN 910) | |
| Enumeration Date | 2011-06-12 |
| Last Update Date | 2020-11-10 |