| NPI | 1154437655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 105077-0501) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: UT 105077-0501) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: UT 105077--0501) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 105077-0501) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2008-04-18 |