| NPI | 1104264456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2334) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001238A) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2024-11-05 |