NPI | 1740849140 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 3171) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 3171) |
Enumeration Date | 2019-06-10 |
Last Update Date | 2025-03-28 |