NPI | 1538643697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0131X (Licence: TX 692195) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 692195) |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 692195) | |
Enumeration Date | 2018-09-24 |
Last Update Date | 2025-07-01 |