| NPI | 1902824600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ND 19) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 431) |
| 213E00000X Podiatrist (Licence: ND 19) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-11-02 |