| NPI | 1235228040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 244086) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IN 07001038A) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-07-15 |