| NPI | 1972814457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KS 12-00486) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2010013287) |
| 111N00000X Chiropractor (Licence: OH DC-04708) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 59.000829) | |
| 111N00000X Chiropractor (Licence: KS 01-05329) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2023-06-14 |