| NPI | 1568462828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OK 120) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OK 120) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2015-08-04 |