NPI | 1376543686 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 685) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 1210) |
213E00000X Podiatrist (Licence: AZ 128) | |
Enumeration Date | 2005-07-28 |
Last Update Date | 2021-05-06 |