| NPI | 1124058672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: UT 103298-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 1032980501) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2014-01-13 |