| NPI | 1528052156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 0548) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 0548) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX 0548) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: TX 0548) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2010-08-27 |