| NPI | 1477016723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 401) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 692082) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2024-08-20 |