NPI | 1144364670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: CO POD-695) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 1801) |
213E00000X Podiatrist (Licence: MO 2006039238) | |
213E00000X Podiatrist (Licence: KS 12-00366) | |
Enumeration Date | 2007-02-17 |
Last Update Date | 2011-08-29 |