| NPI | 1013919471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX DP0780) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX DP0780) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2020-08-11 |