| NPI | 1720081417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 230) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: KY 230) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2008-11-11 |