NPI | 1649260092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX TX 1279) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: TX TX1279) |
213ES0000X Podiatrist, Sports Medicine (Licence: TX TX 1279) | |
Enumeration Date | 2005-10-26 |
Last Update Date | 2022-03-09 |