NPI | 1154693968 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: GA POD000612) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: GA POD000612) |
Enumeration Date | 2012-02-08 |
Last Update Date | 2012-02-08 |