| NPI | 1922337294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1942) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX T09-2009) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2013-05-21 |