| NPI | 1821021957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 367951) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 367951) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2015-01-14 |