| NPI | 1043659055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 9065049-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 9065049-0501) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2025-11-11 |