NPI | 1265475446 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD000478) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA 000478) |
Enumeration Date | 2006-06-14 |
Last Update Date | 2015-10-15 |