| NPI | 1245203322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 0875) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: TX 0875) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: TX 0875) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2013-11-19 |