| NPI | 1184240335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX T21-2020) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 692061) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2025-02-04 |