| NPI | 1801993456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KS 12-00169) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 000465) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2018-09-04 |