| NPI | 1609075720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00326) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 3464) |
| 213ES0131X (Licence: KY 00326) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2025-10-30 |