| NPI | 1891437679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 692242) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 692242) |
| 213ES0131X (Licence: TX 692242) | |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2025-07-07 |