| 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 |