| NPI | 1548648777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 6515828-0501) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: SD 267) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2025-09-03 |