| NPI | 1013438746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 244105) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001408A) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2025-05-18 |