NPI | 1063472306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO000896) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO000896) |
Enumeration Date | 2006-03-23 |
Last Update Date | 2016-07-14 |