NPI | 1568725893 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX T44-2012) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: TX T44-2012) |
Enumeration Date | 2012-06-21 |
Last Update Date | 2014-09-22 |