| NPI | 1689663627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KS 12-00392) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 00657) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2013-02-04 |