| NPI | 1649260092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX TX 1279) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX TX1279) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX TX 1279) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2022-03-09 |