NPI | 1366592867 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 0189) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AZ 0189) |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0189) | |
213ES0131X Podiatrist, Foot Surgery (Licence: AZ 0189) | |
Enumeration Date | 2007-01-10 |
Last Update Date | 2011-06-02 |