NPI | 1043659055 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 9065049-0501) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 9065049-0501) |
Enumeration Date | 2013-06-24 |
Last Update Date | 2016-08-18 |