| NPI | 1821660374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 692101) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX T57-2021) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2024-05-31 |