| NPI | 1871637033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: UT 373091-8907) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: UT 373091-8907) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2017-08-29 |