| NPI | 1891713772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1827) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: TX 1827) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-11-14 |