NPI | 1013250950 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: MT MED-POD-LIC-67915) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: ID P-239) |
Enumeration Date | 2013-03-28 |
Last Update Date | 2021-03-12 |