| NPI | 1053311142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1221) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OK 181) |
| 213E00000X Podiatrist (Licence: AR 134) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2012-05-22 |