| NPI | 1952542698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN DPM750) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY '00317) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN DPM750) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00317) | |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2022-03-16 |