NPI | 1174591150 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 00192) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 205410) |
213E00000X Podiatrist (Licence: MO 000021319) | |
Enumeration Date | 2006-03-08 |
Last Update Date | 2007-07-08 |