| NPI | 1942284377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 244128) |
| Additional Taxonomies | 213EP0504X Podiatrist Public Medicine (Licence: KY 244128) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: KY 244128) | |
| 213ER0200X Podiatrist Radiology (Licence: KY 244128) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: KY 244128) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 270) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 0585) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: KY KY00270) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: KY 244128) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2022-04-26 |