| NPI | 1831163369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 414) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 414) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2015-07-27 |