| NPI | 1851731194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00405) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001237A) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: KY 00405) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: IN 07001237A) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2016-07-15 |