| NPI | 1700816709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: UT 104424-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 104424-0501) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2022-10-25 |