| NPI | 1508980657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: KS 12-00456) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3298) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MO 2007021183) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-02-24 |