NPI | 1255324539 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01223) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC004183R) |
Enumeration Date | 2005-08-23 |
Last Update Date | 2016-03-30 |