| NPI | 1750606802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 1947) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX T28-2009) |
| 291U00000X Clinical Medical Laboratory (Licence: TX 45D2274201) | |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2023-02-16 |