| NPI | 1134196421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX PD573) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX PD573) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX PD573) | |
| Enumeration Date | 2006-03-05 |
| Last Update Date | 2010-10-15 |