| NPI | 1134129158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OK 171) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: OK 171) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 171) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2017-05-04 |