NPI | 1639300486 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 14237422-0501) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC002269L) |
213E00000X Podiatrist (Licence: IN 07000570A) | |
Enumeration Date | 2009-07-28 |
Last Update Date | 2025-09-09 |