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 Podiatrist, Foot Surgery (Licence: KY 00326) | |
Enumeration Date | 2007-07-18 |
Last Update Date | 2018-09-06 |