| NPI | 1477649234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 105275-0507) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 105275-0507) |
| 213ES0000X Podiatrist Sports Medicine (Licence: UT 105275-0507) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2013-10-22 |