| NPI | 1922001551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KS 12-00111) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: KS 12-00111) |
| 213ER0200X Podiatrist, Radiology (Licence: KS 12-00111) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2014-11-17 |