NPI | 1174539530 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0163) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ 0163) |
213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AZ 0163) | |
213ER0200X Podiatrist, Radiology (Licence: AZ 0163) | |
213ES0131X Podiatrist, Foot Surgery (Licence: AZ 0163) | |
Enumeration Date | 2006-07-31 |
Last Update Date | 2021-03-24 |