| NPI | 1013922772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OK 309) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KS T-00718) |
| 213E00000X Podiatrist (Licence: KS 1200357) | |
| 213E00000X Podiatrist (Licence: MO 2012019495) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2017-04-11 |