| NPI | 1356832398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 12286299-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX T17-2018) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 12286299-0501) | |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2024-02-05 |