| NPI | 1376570812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 252) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AR 231) |
| 213E00000X Podiatrist (Licence: OK 252) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-10-24 |