| NPI | 1891357612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OK 384) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 59.000844) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2023-07-07 |