| NPI | 1427245448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 6672822-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 2294) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2024-07-08 |