NPI | 1275581704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AL 212) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AL 212) |
Enumeration Date | 2006-05-05 |
Last Update Date | 2024-05-08 |