NPI | 1285636449 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: CO 540) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: CO 540) |
213E00000X Podiatrist (Licence: UT 3406870501) | |
Enumeration Date | 2005-06-01 |
Last Update Date | 2019-08-19 |