| NPI | 1447713730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 692026) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 692026) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2024-05-17 |