| NPI | 1497049449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 2190) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN 813) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N00716) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: DC PO1000098) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2026-03-05 |