| NPI | 1396364394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 692116) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 692116) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5949) | |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2026-08-27 |