| NPI | 1447656848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 2152) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PR297) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2152) | |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2025-05-29 |