NPI | 1598757551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: LA PD0113) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: LA DPMPD0113) |
Enumeration Date | 2005-08-16 |
Last Update Date | 2025-03-06 |