| NPI | 1669479358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 103861-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 103861-0501) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2014-01-13 |