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 |