| NPI | 1841271095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 5093909-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 5093909-0501) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: UT 5093909-0501) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: UT 5093909-0501) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2021-12-08 |