| NPI | 1376788752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1979) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX T33-2008) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2025-03-07 |