| NPI | 1225415540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 2351) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2351) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2021-01-08 |