| NPI | 1770013245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 692033) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002679) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN 871) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-07-25 |