| NPI | 1053334730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 282785-0501) |
| Additional Taxonomies | 246Q00000X Specialist/Technologist, Pathology (Licence: UT 46D2116123) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-11-28 |