| NPI | 1992784631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1620) |
| Additional Taxonomies | 222Z00000X (Licence: TX 1134) |
| 224P00000X Prosthetist (Licence: TX 1134) | |
| 213E00000X Podiatrist (Licence: TX 1620) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2025-12-03 |