NPI | 1760556765 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: VT VT0560000101) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: NH NH0277) |
213E00000X Podiatrist (Licence: MA MA1543) | |
Enumeration Date | 2006-11-20 |
Last Update Date | 2007-07-08 |