| NPI | 1053593483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KS 12-00370) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1850) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2015-02-26 |