| NPI | 1649295858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 692181) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 692181) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM 185) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2024-09-25 |