| NPI | 1538139621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: UT 12986038-0501) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: UT 12986038-0501) |
| 213E00000X Podiatrist (Licence: NV 0001) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2024-09-20 |