NPI | 1538652839 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NH 0379) |
Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: VT 061.0000025) |
Enumeration Date | 2018-06-11 |
Last Update Date | 2022-01-18 |