| NPI | 1194354621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 284233) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001426A) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 284233) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001426A) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2023-08-17 |