| NPI | 1588821979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KS 12-00473) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NE 337) |
| 213E00000X Podiatrist (Licence: IA 000868) | |
| 213E00000X Podiatrist (Licence: SD 216) | |
| 213E00000X Podiatrist (Licence: KS 12-00473) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SD 216) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2023-04-25 |