| NPI | 1255359642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 243959) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00277) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: KY 00277) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00277) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-11-12 |