NPI | 1518915693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E3216) |
Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: CA E3216) |
213ES0000X Podiatrist, Sports Medicine (Licence: CA E3216) | |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E3216) | |
Enumeration Date | 2006-05-04 |
Last Update Date | 2012-06-28 |