| NPI | 1174570493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 0675) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: TX 0675) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 0675) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2011-04-18 |