| NPI | 1659319721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00313) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO3163) |
| 213E00000X Podiatrist (Licence: KY 00313) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2007-10-30 |