| NPI | 1851957609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: MN 741) |
| Additional Taxonomies | 211D00000X Assistant, Podiatric |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2024-01-17 |