NPI | 1679579759 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: LA DPMLPD027R) |
Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: LA LPD027R) |
Enumeration Date | 2005-06-23 |
Last Update Date | 2014-02-10 |