NPI | 1679956098 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00468) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 41000330A) |
Enumeration Date | 2015-07-02 |
Last Update Date | 2018-06-15 |