NPI | 1629066816 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103000771) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36002143) |
Enumeration Date | 2005-10-11 |
Last Update Date | 2010-07-02 |