| NPI | 1407420862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OK 398) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 398) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2025-07-02 |