| NPI | 1053570903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2009018603) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00319) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2021-04-23 |