| NPI | 1114238953 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2357) | 
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006187) | 
| 213E00000X Podiatrist (Licence: FL PO3607) | |
| Enumeration Date | 2010-06-26 | 
| Last Update Date | 2025-05-01 |