| NPI | 1891793071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1699) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: TX 1699) |
| 213E00000X Podiatrist (Licence: TX 1699) | |
| 213ER0200X Podiatrist, Radiology (Licence: TX 1699) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX 1699) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2022-12-30 |