NPI | 1710306881 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 2272) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36003775) |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2272) | |
Enumeration Date | 2014-04-15 |
Last Update Date | 2025-08-09 |