| NPI | 1316566540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 692031) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY n007211) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2024-04-08 |