| NPI | 1053303727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 234) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 234) |
| 213E00000X Podiatrist (Licence: KY 00234) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2018-02-28 |