NPI | 1336453091 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 0730) |
Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 0730) |
Enumeration Date | 2010-08-04 |
Last Update Date | 2012-02-17 |