NPI | 1316137383 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO4321) |
Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC005768) |
Enumeration Date | 2007-07-26 |
Last Update Date | 2021-11-23 |