NPI | 1245404524 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 351) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 351) |
Enumeration Date | 2008-04-17 |
Last Update Date | 2014-04-22 |