NPI | 1528590924 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 741) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 741) |
213E00000X Podiatrist (Licence: IL 135.000956) | |
Enumeration Date | 2017-04-03 |
Last Update Date | 2020-07-22 |