| NPI | 1124448535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 692096) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 692096) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36003803) | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2024-02-28 |