| NPI | 1770293326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 692220) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 692220) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2025-07-14 |