| NPI | 1871527739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 761) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 761) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-03-07 |