| NPI | 1306940408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY K237) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 244156) |
| 213E00000X Podiatrist (Licence: OH 36003524) | |
| 213ER0200X Podiatrist Radiology (Licence: KY 244156) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 244156) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: KY 244156) | |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2022-03-16 |