NPI | 1043217813 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36-00-2979) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 353) |
213E00000X Podiatrist (Licence: PA SC-00-4569) | |
Enumeration Date | 2005-07-07 |
Last Update Date | 2019-02-21 |