| NPI | 1568532950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 633) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: TX 633) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2014-03-14 |