| NPI | 1346290251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 0598) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 598) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-11-05 |