NPI | 1174634000 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: AL 284) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AL 284) |
213ES0131X Podiatrist, Foot Surgery (Licence: AL 284) | |
Enumeration Date | 2006-08-31 |
Last Update Date | 2022-09-22 |