| NPI | 1265436141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00305) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: KY 244094) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2024-09-23 |