| NPI | 1609876358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1284) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 1284) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX 1284) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: TX 1284) | |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2008-09-10 |