| NPI | 1801329925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 2020013173) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KS 12-00461) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2020013173) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2022-08-29 |