| NPI | 1477969806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 692085) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WV 10448) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301199) | |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2025-03-06 |