NPI | 1750784799 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00485) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001265) |
Enumeration Date | 2014-10-06 |
Last Update Date | 2022-06-08 |