| NPI | 1194724039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1685) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AR 219) |
| 213E00000X Podiatrist (Licence: OK 248) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2022-04-06 |