| NPI | 1770278822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 307479) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 307479) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-07-06 |