NPI | 1457615064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: CO POD.0000936) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AK 110790) |
Enumeration Date | 2012-06-28 |
Last Update Date | 2024-06-25 |