| NPI | 1659443935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1394) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 963253170501) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |