| NPI | 1043212889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1739) |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric (Licence: TX 1739) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2023-04-04 |