| NPI | 1053801019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 243962) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 243962) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001357A) | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2024-02-07 |