| NPI | 1306167762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2053) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 2053) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2025-04-28 |