NPI | 1407822992 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: MA 1682) |
Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: MA 1682) |
Enumeration Date | 2006-02-24 |
Last Update Date | 2016-12-09 |