| NPI | 1891427209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 1223) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 310) |
| Enumeration Date | 2022-06-26 |
| Last Update Date | 2026-07-27 |