NPI | 1346233541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 789) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005214) |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2002014364) | |
Enumeration Date | 2005-08-24 |
Last Update Date | 2024-01-09 |