| NPI | 1164049888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 692219) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 1349-25) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-09-10 |