| NPI | 1154363703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: KS 12-00349) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: KS KS 12-00349) |
| 213ES0000X Podiatrist Sports Medicine (Licence: MO 2005012032) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: MO 2005012032) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2022-04-20 |