NPI | 1679510762 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 00895) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 00895) |
Enumeration Date | 2006-05-31 |
Last Update Date | 2008-01-11 |