| NPI | 1093799249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X (Licence: TX 871) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 0871) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2010-10-04 |