NPI | 1699939116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2026) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006062) |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO POD.0000790) | |
Enumeration Date | 2008-07-14 |
Last Update Date | 2018-10-02 |