NPI | 1659370641 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: DC P0546) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 1204) |
Enumeration Date | 2005-07-20 |
Last Update Date | 2015-12-23 |