| NPI | 1124106927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 3114) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 3114) |
| 213E00000X Podiatrist (Licence: CA E4101) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2024-01-16 |