| NPI | 1184240855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 692067) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX T20-2020) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2023-12-15 |