| NPI | 1609215755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NE 375) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KS 12-00417) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2019-01-30 |