NPI | 1154337046 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: UT 104906-0501) |
Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: UT 104906-0501) |
Enumeration Date | 2006-07-31 |
Last Update Date | 2007-07-08 |