NPI | 1306256599 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NC 657) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 657) |
213ES0131X Podiatrist, Foot Surgery (Licence: NC 657) | |
Enumeration Date | 2014-04-28 |
Last Update Date | 2021-02-16 |