| NPI | 1972913069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00448) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR DP198503) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2023-09-12 |