NPI | 1386616415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NC 740) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 740) |
213ES0131X Podiatrist, Foot Surgery (Licence: NC 740) | |
213E00000X Podiatrist (Licence: NC 740) | |
Enumeration Date | 2006-02-02 |
Last Update Date | 2016-10-19 |