NPI | 1487656104 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO2417) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO8041) |
Enumeration Date | 2005-08-12 |
Last Update Date | 2020-01-03 |