| NPI | 1063680668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 102232-0501) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: UT 102232-0501) |
| 213ER0200X Podiatrist Radiology (Licence: UT 102232-0501) | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2012-08-28 |