| NPI | 1275742074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM 402) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM 311) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1933) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-03-17 |