| NPI | 1033452263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 9763801-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY P84626) |
| Enumeration Date | 2013-04-06 |
| Last Update Date | 2022-07-21 |