NPI | 1700830403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: SC 107) |
Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SC 107) |
213E00000X Podiatrist (Licence: SC 107) | |
213ES0131X Podiatrist Foot Surgery (Licence: SC 107) | |
Enumeration Date | 2006-05-19 |
Last Update Date | 2022-08-11 |