NPI | 1649276007 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: LA DPM.PD290R) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: LA PD290R) |
Enumeration Date | 2005-06-21 |
Last Update Date | 2024-11-13 |