| NPI | 1760480818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 244077) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: IN 07000919A) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: KY 00174) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-01-30 |