NPI | 1801071550 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: ID P-142) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: ID P1423) |
Enumeration Date | 2007-12-31 |
Last Update Date | 2023-10-17 |