| NPI | 1669811915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 0838) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT INTERN) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2022-03-02 |