| NPI | 1700944634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 650) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 650) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-11-07 |