NPI | 1760469688 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC004755L) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC004755L) |
Enumeration Date | 2005-12-30 |
Last Update Date | 2024-09-04 |