NPI | 1669441895 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: SC 533) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 533) |
Enumeration Date | 2006-03-17 |
Last Update Date | 2011-04-05 |