NPI | 1679143036 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007198) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA Sc007198) |
Enumeration Date | 2021-06-29 |
Last Update Date | 2024-06-18 |