| NPI | 1073950440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 9114085-0501) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: UT 9114085-0501) |
| Enumeration Date | 2013-05-25 |
| Last Update Date | 2024-01-02 |