NPI | 1518206945 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MD 01559) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 01559) |
Enumeration Date | 2013-02-05 |
Last Update Date | 2020-09-28 |