| NPI | 1255328654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KS 12-00167) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 000415) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2017-04-17 |