| NPI | 1093713539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 314121-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 314121-0501) |
| 213E00000X Podiatrist (Licence: NV 9203) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NV 9203) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2014-01-13 |