| NPI | 1922112515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MN 743) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2005015461) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2018-10-15 |