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Individual
NHI LE
Active
Individual
NHI LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
12-00499
KS
213E00000X
Podiatrist
Primary
2024027136
MO
213ES0103X
Foot & Ankle Surgery Podiatrist
2024027136
MO
213ES0131X
Foot Surgery Podiatrist
12-00499
KS
Other
Enumeration date
03/23/2021
Last updated
04/30/2025
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