| NPI | 1912908435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 620) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 620) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MN 620) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2018-03-17 |