| NPI | 1013005412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00331) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00331) |
| 213ER0200X Podiatrist Radiology (Licence: KY 00331) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2013-03-13 |