NPI | 1336566025 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2102) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 2102) |
Enumeration Date | 2014-03-20 |
Last Update Date | 2025-09-16 |