NPI | 1073880936 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 1049-25) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1049-25) |
Enumeration Date | 2011-11-21 |
Last Update Date | 2022-07-21 |