| NPI | 1699774463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: TX 1676) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: TX 1676) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2024-05-15 |