| NPI | 1003179193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NM POD387) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 8718615-0501) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 8718615-0501) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM POD387) | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2018-10-10 |