NPI | 1124089842 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3515) |
Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: FL PO3515) |
213ES0000X Podiatrist, Sports Medicine (Licence: FL PO3515) | |
Enumeration Date | 2006-03-31 |
Last Update Date | 2024-06-06 |