NPI | 1023010279 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 244122) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: KY 244122) |
213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: KY 00180) | |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00180) | |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 244122) | |
Enumeration Date | 2005-06-01 |
Last Update Date | 2021-07-07 |