| NPI | 1942879960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 692106) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 692106) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: TX 692106) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: TX 692106) | |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-05-25 |