| NPI | 1295230118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 282269) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213E00000X Podiatrist (Licence: CO POD.0000876) | |
| 213E00000X Podiatrist (Licence: KY 282269) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO POD.0000876) | |
| Enumeration Date | 2018-03-25 |
| Last Update Date | 2025-06-20 |