NPI | 1184245532 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4604) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO4604) |
Enumeration Date | 2020-04-27 |
Last Update Date | 2025-03-17 |