NPI | 1265819700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO4111) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4111) |
Enumeration Date | 2015-05-05 |
Last Update Date | 2024-04-17 |