| NPI | 1932309812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2024) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 2024) |
| 213ES0131X (Licence: TX 2024) | |
| 213E00000X Podiatrist (Licence: TX 2024) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2015-03-21 |