| NPI | 1114130747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KS 12-00365) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KS T-01205) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2013-10-11 |