| NPI | 1891780391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 1806) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 682) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2008-03-14 |