| NPI | 1043213168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 102832-0501) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: UT 0582870001) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2018-04-24 |