NPI | 1063494847 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000305) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CT 000305) |
Enumeration Date | 2005-11-16 |
Last Update Date | 2007-07-08 |