| NPI | 1063771715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00443) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001153) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2016-08-02 |