| NPI | 1285616375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KS 12-00315) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2000168834) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2014-10-22 |