| NPI | 1013915701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OK 192) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: OK 192) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 192) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2010-02-16 |