NPI | 1922294768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 364378-0501) |
Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: UT 364378-0501) |
Enumeration Date | 2007-09-14 |
Last Update Date | 2016-06-23 |