NPI | 1104383512 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4242) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO4242) |
213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO4242) | |
213ES0000X Podiatrist, Sports Medicine (Licence: FL PO4242) | |
213ES0131X Podiatrist, Foot Surgery (Licence: FL PO4242) | |
Enumeration Date | 2019-02-22 |
Last Update Date | 2024-08-12 |