NPI | 1568573251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: CA E4392) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC004502L) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2015-04-01 |