| NPI | 1013051960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX L2673) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: TX l2673) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2019-05-14 |