| NPI | 1821522962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KS 1200467) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NM POD438) |
| Enumeration Date | 2017-04-15 |
| Last Update Date | 2022-02-16 |