| NPI | 1528162161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WV 10393) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 10393) |
| 213E00000X Podiatrist (Licence: KY 00445) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00445) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2021-11-17 |