| NPI | 1679198436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 265917) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 41000415A) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2023-07-27 |