| NPI | 1801962121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 9704032-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NM 323) |
| 213E00000X Podiatrist (Licence: ID P-264) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2024-10-16 |