NPI | 1144843111 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO4608) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4608) |
213ES0131X (Licence: FL PO4608) | |
Enumeration Date | 2020-05-25 |
Last Update Date | 2024-09-24 |