| NPI | 1629213780 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 7081436-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0718) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1946) | |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2019-03-28 |