| NPI | 1790781292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 5336197-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 5336197-0501) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2024-08-29 |