NPI | 1457315509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MD 01118) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC-003472-L) |
Enumeration Date | 2006-04-14 |
Last Update Date | 2007-07-08 |