NPI | 1386634301 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: TN DPM0000000357) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM0000000357) |
Enumeration Date | 2005-10-21 |
Last Update Date | 2013-07-12 |