| NPI | 1992701544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MN 566) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MO 2012013991) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: KS 12-00393) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MN 566) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2014-04-04 |