| NPI | 1992167902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 729) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 246411) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001304A) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2021-12-07 |