| NPI | 1154337046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: UT 104906-0501) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: UT 104906-0501) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |