| NPI | 1538192406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 378898-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 378898-0501) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2010-02-17 |