| NPI | 1558500801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 1911) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL P03358) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2020-01-30 |