| NPI | 1851385488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1742) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 1742) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX 1742) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: TX 1742) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: LA PD0144) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2023-01-02 |