| NPI | 1689058356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001281A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 243967) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00433) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2019-11-19 |