| NPI | 1992709869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: TX 1551) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 1551) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 1551) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2020-09-01 |