| NPI | 1326046590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1583) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 1583) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX 1583) | |
| 213ES0131X (Licence: TX 1583) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2023-01-25 |