| NPI | 1376546051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 0359) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 0359) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2015-01-27 |