| NPI | 1487625364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: MO 2000161864) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: KS 12-00320) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2014-11-26 |