| NPI | 1962571067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 1177) |
| 208600000X Surgery (Licence: TX 1177) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2009-11-19 |