NPI | 1619397643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3892) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO3892) |
213ES0000X Podiatrist, Sports Medicine (Licence: FL PO3892) | |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3892) | |
213ES0131X (Licence: FL PO3892) | |
Enumeration Date | 2014-04-17 |
Last Update Date | 2025-03-10 |