NPI | 1538145974 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO1387) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO1387) |
Enumeration Date | 2005-12-19 |
Last Update Date | 2012-05-21 |