NPI | 1326047846 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO2948) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: AL 257) |
213E00000X Podiatrist (Licence: LA PD0103) | |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO 2948) | |
Enumeration Date | 2005-07-18 |
Last Update Date | 2023-02-16 |