| NPI | 1669606414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1890) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: TX 1890) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 1890) | |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2025-04-30 |