| NPI | 1013152677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 244011) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00374) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 59 000258) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 0374) | |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2023-02-13 |