| NPI | 1083029235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 243992) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IN 07001246A) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2021-07-15 |