NPI | 1649894569 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 13244494-0501) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5951001364) |
Enumeration Date | 2020-06-06 |
Last Update Date | 2023-04-05 |