| NPI | 1598004061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 2080) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: TX 2080) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2080) | |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2022-03-21 |