| NPI | 1972917961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2350) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX T50-2014) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2021-10-27 |