| NPI | 1811968555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WV 10396) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001001A) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00282) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2022-12-05 |