NPI | 1053574392 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WV 02207) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0103301039) |
Enumeration Date | 2008-07-07 |
Last Update Date | 2022-05-05 |