| NPI | 1548236946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY KY175) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: KY KY175) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2007-07-08 |