NPI | 1144819533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: LA 328578) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO4234) |
Enumeration Date | 2021-01-11 |
Last Update Date | 2022-08-09 |