NPI | 1609190032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WY 140) |
Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CO POD.0000718) |
Enumeration Date | 2010-03-14 |
Last Update Date | 2021-01-28 |