| NPI | 1649652256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2328) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX T44-2015) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-12-21 |