| NPI | 1861594624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 5088169-0501) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: UT 5088169-0501) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2007-11-09 |