| NPI | 1346358843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 244150) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 246) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: KY 00246) | |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2023-11-11 |