| NPI | 1578585139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN dpm379) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM379) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-05-21 |