| NPI | 1750732707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 243961) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00452) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2019-07-02 |