| NPI | 1215935671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 244161) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 274) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2019-09-19 |