| NPI | 1487847331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 00353) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07000975A) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2021-05-11 |