| NPI | 1255338992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1657) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1657P) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-12-03 |