NPI | 1790188514 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PR384) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PR384) |
Enumeration Date | 2014-10-07 |
Last Update Date | 2023-08-21 |